When you ligate the GDA (proximal), you must preserve the IPDA. However, in an extended Whipple, you remove the IPDA, relying entirely on pancreatic arcades. Ischemic necrosis of the residual pancreas is a fatal complication of over-resection.
Endoscopic Retrograde Cholangiopancreatography (ERCP) image. SURGICAL ANATOMY OF THE PANCREAS.ppt
The Map Behind the Curtain
A tiny, pale white line—the main pancreatic duct. It can be 1mm or 3mm. It can be absent, split, or looping. Never assume. Always probe. Elara smiled grimly. She had once spent forty minutes searching for a duct in a fatty pancreas, only to find it running dorsally, laughing at her. When you ligate the GDA (proximal), you must
Extends to the left of the superior mesenteric vessels, passing anterior to the aorta and the left kidney. Endoscopic Retrograde Cholangiopancreatography (ERCP) image
This article expands upon the core slides of such a presentation, offering a detailed textual exploration of the surgical anatomy of the pancreas, focusing on topography, vascular relationships, lymphatic drainage, and the anatomical basis for common surgical procedures.